8885_DEICHMAN, MIKE_19910904

CAMA AND DREDGE AND FILL
GENERAL
PERMIT
as authorized by the State of North Carolina,
Department of Natural Resources and Community Development and t e C ptal Resources Commission
in an area of environmental concern pursuant to 15 NCAC /M
Applicant
Address
City
Project � ocationCounty,, State Road, Water Body, etc.)
Type of Project Activity
PROJECT DESCRIPTION KETCH
°ier (docth —
Groin length
number
Bulkhead length
max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
I Othe
State /j/ ,C
I / 1,44) Y
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
Phone Number � �? ?_ ) � / 3 `e__
zip Iq 4, Slv ,
(SCALE: -
/� a plicant's signature
V
permit officer's signature
issuing date expiration date
attachments �c/ / C �, �/ / �, 1�1 61
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
1-1
application fee m O 0 6� J�,� 6

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. ADJACENT RIPARIAN PROPEM Y OWNER STATEMENT
. (FOR' A• PIER) •
I hereby pertify that I own 'property .adjacent to
's property located at
(xame of.P operty Owner)
02
(Lot, Block, Road, etc.)
a on l:s6N �(lFiFc� , ,finF..u) �Fc/ Cl&,ja •: N.C.
(Waterbody) -(Town and/or County)
He has 'described 'to ,me,. as shown. below, the development he '.is
poposing:at that location, and, I have.no objections to his
{ proposal.`' ,-I understand that a•.pier must be set back a minimum
distance of, fifteen feet;' (151) from my area - of riparian access.
unless waived by me.
.. / I.do not wish to waive that setback requirement.
_..` I do wish to waive : that setback requirement.
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' `` • DESCRIPTION'^*`a ratNG �7^•• 'PROPOSED V DEVELOPMENT •
..t .
('ro be filled ink by. -proposing: development)
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PL.000
Telephone Number

ADJACENT RIPARIAPI PROPERTY OWN7R STATEMENT
(FOR A- PIER)
I hereby oerti•fy )that I own property .adjacent to
I C 6,-C4 vv :ma's property located at
(Name of P operty Owner)
(Lot, Block, Road, etc.)
-on LIUS 614 C g/trx- , n N15a) t?&Zo C � ,. N.C.
(Waterbody) (Town and/or County)
He has'described-to me,,. as shown below, the development he -.is
proposing At that location, and, I have. no objections to his
proposal.•I understand that a•pier must be set back a minimum
distance of fifteen feet; (151) from my area - of riparian access
unless waived by me.
L do not wish to.waive that setback requirement.
I do wish to k!aive.:that setback requirement.
DESCUPTION A? _/'J_^..^.'^_�w�NG 4:'• PROPOSED DEVELOPMENT:
\ (To be filled in by..^d-:i ridual- -proposing development)
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